CHAPTER 1

INTRODUCTION
Every work will be successful, only if its goal oriented. Need based approach is helpful to fulfill the need and satisfying whenever concerned. Its very clear that breast feed is an essential factor to maintain & promote the health for less than two years. Breast milk, the Cinderella substance of the decades is a natures most precious gift to new born. Its the best gift that a mother can give to her baby. Breast feeding of human infants has been a common feature irrespective of culture and time all over the World. The other modes of feeding has differed as to what, when ,how & by whom to feed the.Breast milk is the ideal milk for both rich and poor babies.

BACKGROUND
Breast feeding is the normal way of providing young infants with the nutrients they need for normal growth and development. Breast milk is nutritionally superior, nutrients are in an optimum proportion and in a form that is easily digested and absorbed. Breast feeding quiets a noisy or fussy child, relaxes an anxious child, comforts a sick, injured or frightened child and conveys that the child is safe & loved. Breast feeding is a natural way of bonding with your child. Nursing and holding the child close cause the brain to release a hormone like substance oxytocin. Oxytocin gets pronounced with the skin to skin contact. The hormone has been called the love hormone or the cuddle hormone or the bonding hormone. It provides a sense of well being and helps the mother and child to bond together. It helps in developing motherly feelings after birth to a child.

Breast feeding works best when its done on-demand, in other words whenever a baby wants to or shows clue of wishing to nurse. To get the maximum benefits, the breast feeding must be exclusive. Colostrum, the yellowish thicker breast milk produced in the first few days, must be given. Its recommended by WHO as the perfect food for the new born and feeding should be initiated within the first hour after birth. Exclusive breast feeding is recommended upto 6 months of age, with continued breast feeding along with appropriate complementary foods upto 2 years of age or beyond. UNICEF 1996 states malnutrition today is the most widespread and serious problem affecting young childs health, combined with infections like pneumonia, diarrhoea ,etc. This is a major cause of death in developing Countries. Malnutrition is the result of interplay of interacting and related factors in the individual, family, community example financial, social and human resources like knowledge, motivation, health practices, hygiene practices etc. and affects at least 150 million of children under 5 years of age in developing countries only.

10 STEPS TO SUCCESSFUL BREAST FEEDING; Every facility providing maternity services and care for new born and infants should: 1. Have a written breast feeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breast feeding. 4. Help mothers initiate breast feeding within half hour of birth, 5. Show mothers how to breast feed and how to maintain lactation even if they should be separated from this infants.

6. Give new born infants no food or drink other than breast milk, unless medically indicated. 7. Encourage breast feeding on demand. 8. Practice rooming-in and allow mother & infants to remain together 24 hours a day. 9. Give no artificial teats or soother to breast fed infants. 10. Foster the establishment of breast feeding group and refer mother to them on discharge from hospitals/clinics.

NEED OF THE STUDY

Breast milk is the most precious gift to the new born. Its the ideal source of nourishment for infants during the first 6 months of life. Breast feeding is an unequal way of providing ideal food for the normal growth and development of infants. At the same time it has a unique biological and emotional influence on the health of both mother and baby. Breast feeding involves instinctive behavior and learned behavior. Its success depends on physical and psychological factors. Breast feeding is considered as an integral part of childs rearing. To assess whether the mother is having a favourable or unfavourable attitude towards breast feeding, the knowledge of existing pattern of breast feeding is essential. Breast milk contains a number of anti-infective factors which protects the child from several bacteria and viral infections. Breast fed babies are less likely to develop infection, Breast milk also counters the risk of allergic disorders. Its the responsibility of mothers to give breast milk & keep the children healthy.

Breast feeding pattern comprises of initiation of breast feeding with proper position of mother and baby, schedule and duration of feeding and care of breast before feeding child. The study of pattern reveals the existing practices of breast feeding among mothers in a particular community and provides baseline data for several educational programs. Breast feeding is a natural foundation for infants health and nutrition. Therefore multiple actions are needed to conserve and support this practice. When income is low and education is poor, the superiority of breast feeding becomes ever more marked and breast feeding is the only way of giving a child a free chance of survival. Though the practices of breast feeding hold a right place in India, it has been observed that people who migrate from rural to urban slums are influenced by people around them. Women go out for work, bottle feeding is likely to be taken as a convenient method of feeding yet its dangerous. All children have 3 important needs to be help achieve their full potential: A feeling that they are loved. Their stomachs are supplied with wholesome food They have freedom from infections Infant feeding practices can gently influence the nutritional status of children. A child feels loved and is well nourished, has a low risk of getting infections.

Children are vulnerable to emergencies and their mortality can be very high in emergencies than in normal cases. Breast feeding has been acknowledged as a life saving intervention. Even in non-emergency settings, non-breast fed babies less than 2 months are 6 times more likely to die.

ADVANTAGES OF BREASTFEEDING

FOR BABY

1. Due to the anti-infective properties of breast milk, breastfed babies tend to have less incidence of or less pronounced symptoms of ear infections, respiratory illness, allergies, diarrhea, and vomiting. 2. Due to the digestibility of breast milk, breastfed babies are rarely constipated. 3. The stools of breastfed babies are mild-smelling. 4. SIDS (Sudden Infant Death Syndrome) is less common in breastfed babies. 5. Breast milk is constantly changing in its composition to meet the changing needs of the baby. It has the exact combination of protein, fats, vitamins, minerals, enzymes, and sugars needed for the human infant at various stages of his growth. 6. Breastfed babies are constantly exposed to a variety of tastes through their mother's milk. 7. Breastfed children are at less risk for chrohn's disease and juvenile diabetes. 8. Children who were breastfed are less likely to need orthodontic work such as braces due to the unique sucking action required with breastfeeding. They also seem to have better overall dental health than formula-fed children. Children who were breastfed need speech therapy less often than those who were bottle-fed. 9. IQ levels are an average of 8 points higher in children who were breastfed. 10. Adult daughters who were breastfed are at less risk for breast cancer. 11. Adults who were breastfed have a lower risk for high cholesterol and asthma. 12. The bond between mother and child seems to be enhanced with breastfeeding.

FOR MOTHER

1. Nursing immediately following delivery causes the uterus to contract lessening the risk of postpartum hemorrhage. 2. The uterus of a breastfeeding mother shrinks to its pre-pregnancy size more quickly. 3. Calories are burned while breastfeeding. It takes approximately 20 calories to produce an ounce of milk. 4. Women who nurse their babies for at least 6 months lessen their chances of premenopausal breast cancer. 5. Osteoporosis and cervical cancer are less common in women who breastfed. 6. The return of fertility is delayed with breastfeeding. 7. Breastfeeding is more economical than formula feeding. 8. Breast milk is always available, clean, and the right temperature. 9. Many mothers feel a special satisfaction in knowing that they alone are meeting the nutritional needs of their babies.

DIFFERENT POSITIONS FOR BREAST FEEDING:

1. CRADLE HOLD METHOD: Is the most common position of all. This position is best for the older baby who already has control over head and neck movement and can catch on easily. 2. CROSS CRADLE METHOD: Allows a mom complete control during breast feeding. The position is used for the newborn and only until baby has learned to catch on correctly. 3. FOOTBALL HOLD METHOD: Baby is held on either of the sides. This is a great position for mothers who have just had a caesarean section, mothers with large breast, heavy let down reflexes and premature babies. 4. LYING METHOD: Is the easiest position for many moms and is nice for those who sleep with their babies.

FACTORS AFFECTING BREAST FEEDING

1. SOCIO-DEMOGRAPHIC FACTORS: Includes age, marital status, education and income level. These factors are not amendable to change by anyone once the women is pregnant. Knowing that successful longer term breast feeding is inversely correlated with being young and undereducated.

2. BIOPHYSICAL FACTORS: Including intrapartum experiences. The women birth experiences impacts upon their behaviors, particularly the successful initiation of breast feeding. For instance, there is negative association between caesarean delivery and breast feeding initiation and a positive association between birth centre. Many studies have shown, however that once breast feeding has been established birth experiences do not have a lasting effect on breast feeding duration. Similarly breast feeding difficulties including nipple pain do affect short term breast feeding duration but no longer term duration. Women who experiences problems develops greater self- efficiency and that is positively associated with breast feeding longer as the women develops confidence in her ability to solve breast feeding problems. Insufficient milk supply is one of the most common reasons women given breast feeding cessation. This is a biological factor which has a strong psychological component. Its generally to be more perceived than real, there must be other factors at play that cause the women to doubt their milk supply. The women who doubt their ability may perceive insufficient milk supply and start complementary foods.

3. PSYCHOSOCIAL FACTORS: These are often amendable to antenatal intervention. For instance, strength of the intentions to breastfeed, the level of support from partner and family origin and the level of womens breast feeding confidence are all amendable to being strengthened by antenatal interventions.

4. SOCIO-CULTURAL & RELIGIOUS FACTORS: Some communities strongly discourage to feed the child with colostrum. Instead, they appreciate to feed the child with some janam ghutti or honey. Not only this ther delay the breast feeding process as they believe in performing some religious rituals done by the elder members of the family.

WEANING
DEFINITION: Weaning is the process of gradually introducing a infant to what will be its adult diet and withdrawing the supply of its mother's milk. The infant is considered to be fully weaned once it no longer receives any breast milk (or bottled substitute). Weaning is the term used to describe the process of switching a baby from: * Breast-feeding to bottle-feeding. *Breast- or bottle-feeding to a cup. *Breast- or bottle-feeding to solid foods. Baby will go through one or more of these weaning processes. All types of weaning usually work best when they are done graduallyover several weeks, months, or even longer.

BEST TIME OF WEANING: There is no right or wrong time. And there is no correct length of time that it should take. It depends on how ready you and your child are to start weaning. Some moms wait longer because they are not ready to give up the closeness that breast-feeding brings. Others are ready to wean sooner or have responsibilities or life changes that make it necessary.

BEST METHOD OF WEANING: Gradual weaning is best for both babies and moms. Look for signs that your baby is ready. When you are both ready, try dropping one feeding every 5 to 7 days. This will help give you and your baby time to adjust to new ways of feeding. If you are breast-feeding, gradual weaning helps keep your breasts from becoming too full, a problem called breast engorgement.

STATEMENT OF PROBLEM

A study on exclusive breast feeding in terms of knowledge and practice of mothers in a selected community, New Delhi.

EXECUTIVE SUMMARY

A study was conducted to evaluate the knowledge level and practice of mothers in a selected community in New Delhi along with the various factors contributing to the successful exclusive breastfeeding along with the weaning foods. Breast feeding is the normal way of providing young infants with the nutrients they need for normal growth and development. Breast milk is nutritional superior, nutrients are in an optimum proportion and in a form that is easily digested and absorbed. An interview was conducted to find out the various practices being conducted and the knowledge level of the mothers regarding the topic.

Annexure-I

CERTIFICATE

This is to certify that the project work entitled A study on exclusive breast feeding in terms of knowledge and practice of mothers in a selected community, New Delhi is a bonafide work of Ankita.R.Lal student of One Year Post Graduate Diploma In Health Promotion 2012-2013 in National Institute Of Health And Family Welfare. This work has been carried out under my supervision.

Name Of The Supervisor With Signature, Designation, Name Of The Organization.

Annexure-II

DECLARATION

I Ankita.R.Lal hereby declare that the project work entitled A study on exclusive breast feeding in terms of knowledge and practice of mothers in a selected community, New Delhi is an original work carried out by me under the guidance of Dr.Jyoti Sharma, Medical Officer Incharge DGD-Dujana House Jama Masjid, New Delhi.

MS.ANKITA.R.LAL

INTERVIEW SCHEDULE

1. NAME OF CLIENT 2. MATERNAL AGE (a).below 20 years (b).21-25 years (c).26-30 years (d).31 and above 3. RELIGION (a).hindu (b).muslim (c).christian (d).any other 4. OCCUPATION OF MOTHER (a).housewife (b).laborer (c).professional (d).any other

5. MONTHLY FAMILY INCOME (a).below Rs.5000 (b).Rs.5000-10,000 (c).Rs.10,000-15,000 (d).above Rs.15,000 6. TYPE OF FAMILY (a).nuclear (b).joint 7. EDUCATION OF MOTHER (a).no formal education (b).secondary(10th standard) (c).senior secondary(12th standard) (d).any other 8.GRAVIDAE (a).primi (b).multi 9. EXPOSURE TO HEALTH EDUCATION (a).yes (b).no

10. IF YES, SOURCE OF EDUCATION (a).health worker (b).family (c).magazine/radio/Tv (d).all of the above 11. DOES YOUR HUSBAND/ FAMILY MEMBERS SUPPORT FOR BREAST FEEDING? (a).yes (b).no 12. DIETARY HABITS (a).vegetarian (b).non-vegetarian 13. WHICH IS THE BEST MILK FOR THE NEWBORN? (a).cows/buffalos milk (b).breast milk (c).packet milk (d).formula milk 14. WHAT WOULD YOU PREFER TO FEED YOUR CHILD SOON AFTER BIRTH? (a).sugar/glucose water (b).cows milk (c).breast milk (d).honey/janam ghutti

15.WHAT ARE THE PSYCHOLOGICAL BENEFITS FROM BRESTFEEDING FOR THE MOTHER AND CHILD? (a).psychological satisfaction for the baby and mother (b).strengthen mother child bonding. (c).emotional satisfaction for the mother (d).an obstruction for babys psychological growth 16. WHAT ARE THE ADVANTAGES OF BREAST FEEDING FOR BABY? (a).easily digestible (b).improves the immunity of the child. (c).physical development (d).all of the above 17. WHAT ARE THE ADVANTAGES OF BREAST FEEDING FOR MOTHER? (a).helps in child spacing (b).it prevents common breast problems. (c).saves time and energy for preparation of milk. (d).all of the above 18.WHEN TO START BREAST FEEDING? (a).first day of birth (b).second day of birth (c).third day of birth (d).within half an hour of birth

19. WHAT IS COLOSTRUM? (a).the first, bright yellow milk from the breast (b).it is blue in color (c).it is packed milk (d).it is residue milk soon after birth 20. HOW DOES COLOSTRUM PREVENTS DISEASE? (a).provides immunity to child. (b).it contains vitamin-B (c).it contains RBC (d).do not know 21. ADVANTAGES OF COLOSTRUM? (a).it is a good source of vitamin-A and protects the baby from diseases. (b).baby likes it more. (c).it removes secretion from the stomach by vomiting. (d).do not know. 22. ADEQUATE BREAST MILK IS INDICATED? (a).if the baby demands for milk. (b).if the baby gains weight. (c).if the baby micturates six times a day. (d).both (b) and (c)

23. HOW DO YOU CLEAN YOUR HANDS BEFORE FEEDING YOUR BABY? (a).wash with water (b).wash with lotion (c).wash with soap and water (d).wipe with wet cloth. 24. WHY IS IT NECESSARY TO WASH HAND BEFORE GIVING FEEDING? (a).to reduce the number of micro-organism (b).to maintain its shape (c).to moisturize it. (d).do not know. 25. HOW WILL YOU CLEAN YOUR BREAST? (a).wash with lotion (b).wash with water (c).wash with soap and water. (d).wipe with cloth. 26. HOW FREQUENTLY DO YOU CLEAN YOUR BREAST? (a).before and after each feed (b).only before feed (c).once in a while (d).never

27. HOW WILL YOU HOLD YOUR BABY FOR BREAST FEEDING? (a).hold the baby conveniently. (b).place the head on the palm of your hand (c).hold the baby close to your body, head slightly raised on the crook of the elbow (d).do not know. 28. HOW DO YOU PREFER TO BREAST FEED FOR ONE SESSION? (a).both sides for one session (b).one side for one session (c).always right/left side (d).no preference. 29. WHEN DO YOU START FEEDING YOUR CHILD WITH WEANING FOODS? (a).immediately after birth (b).after 6 months (c).when desired (d).do not know

ACKNOWLEDGEMENT
I express my dedication and sincere gratitude to the almighty God who blessed me with his abiding grace throughout the study which has made this possible. A word of whole hearted gratitude to my parents who constantly motivated me to undertake and complete my project. I express out deep sense of gratitude to Dr.Sanjiv Sharma, Dr. A.K Sood, Dr.Poonam khattar and all the other co-ordinators for their enduring support, suggestion and valuable encouragement & time to time in the course of study. Iam extremely obliged to all the experts in refining my topic. The present study has been undertaken and completed under the expert guidance, support and immense encouragement of Dr.Jyoti Sharma. I express my deep sense of gratitude and indebtedness to the advices for her constant guidance and keen interest in the subject. Its indeed a great honor and privilege to be guided by her since she benefitted me immensely with her critical comments, constant availability and continous inspiration right fom the planning phase till the completion of the study. I also express my sincere indebtedness towards DGD-Dujana house,jama masjid for granting permission to conduct my project. A word of commendation to all the colleagues, well wishers and all other who assisted , guided, co-operated and gave moral support for the successful completion of the project.

REVIEW OF LITERATURE
This chapter presents a brief of literature for the present study. According to Polit and Hungler a literature review involves the systematic identification, location, scrutinizing and summary of written materials that contains information on a research problem. Familiarizing with practical of theoretical issues helps the researcher to generate ideas or focus on a research topic.The review of literature throws light on the type of the study and its findings. A brief report of the reviewed literature is given under the following heading: * concept of breast feeding. *studies related to the knowledge and practices of mothers regarding breast feeding. Literature related to the concept of breast feeding: Milk is produced as a result of interaction between hormones & reflexes. Prolactin produced by an anterior pituitary gland is responsible for milk secretion, babys sucking stimulates milk secretion reflex. Its important to mothers to feed early, frequently and completely emptying the breast at each feed. Oxytocin produces by the posterior pituitary is responsible for the milk ejection reflex. A relaxed and confident attitude helps in milk ejection reflexes. According to Department Of Pediatrics Maulana Azad Medical College, New Delhi April 24,2009 the exclusive breast feeding rates in India at 6th month is about 46%. At 6-8th month only 54% of the breast feeding & 75% on non breast fed infants are initiated into complimentary foods. At the start of the second year of life only about 42% of the infants received the recommended appropriate foods at appropriate frequency. There is evidence to suggest that the persistent undernutrition in the Country is associated with these inadequate feeding practices prevalent in the Country.

According to National Institute Of Child Health & Human Development 2010 breast feeding offers many benefits to your baby. Breast milk contains the right balance of nutrients to help your infant grow into a strong and healthy toddler. Some of the nutrients in breast milk also helps protect your infant against some common childhood illnesses and infections. It may also help improve your health. Women who dont have health problems should try to give their babies breast milk for at least 6 months of life. Bangladesh Demographic & Health Surveys (BDHS) 1999,2004,2007 reported the prevalence of exclusive breast feeding (defined as giving only breast milk not even water) among infants below 6 months of age has not increased in the past 12 years. The exclusive breast feeding rate remained unchanged at around 45% in the years 1993 & 1999 surveys and then declined to 42% in the year 2004 with no notable improvement there after. BDHS 2007 reports the mean duration of exclusive breast feeding to be 3.3 months. Initiation of breast feeding within one hour of birth however is reported to have increase from 24% in 2004 to 43% in 2007. According to US,National Institute Off Health 2011 the health professionals advising mothers on the introduction of solid foods to infants need evidence-based guidelines. A literature review on this topic was undertaken to examine the current international recommendations of expert bodies and evidence-based research published since 2003. Particular reference in this review is made to the timing of introducing food allergens and the risk of development of allergy in the child. Recommendations in developed countries of reducing this risk by avoidance of allergenic foods until the child is of varying ages past 6 months have been challenged by recent population studies. Where the risk of allergy is a key consideration, currently-available research suggests that introducing solids at 4-6 months may result in the lowest allergy risk. When all aspects of health are taken into account, the recommended duration of exclusive breastfeeding and age of introduction of solids were confirmed to be 6 months, but no later. According to WHO May 2012 Member States of the United Nations reaffirmed the relevance and the urgency of the four Innocenti targets in the WHO/UNICEF Global Strategy for Infant and Young Child Feeding adopted by the World Health Assembly. The Global Strategy includes five additional operational targets: appointment of a national breastfeeding coordinator with appropriate authority, and establishment of a multisectoral national breastfeeding committee; implementation of 'Ten steps to successful breastfeeding' (i.e., the Baby-Friendly Hospital Initiative) in all maternity facilities;

global implementation of the International Code of Marketing of Breast-Milk Substitutes and subsequent relevant World Health Assembly resolutions in their entirety; and enactment of imaginative legislation to protect the right of working women to breastfeed and establishment of means for enforcing legislation on maternity protection. The Sri Lankan DHS 2010 reported, "Among infants 0-5 months of age, the percentage of exclusively breastfed infants was 75.5%". This is the average rate of breastfeeding among infants aged 0-5 months. The same survey has reported the breakdown of this rate as age specific rates. According to these rates, among infants aged 4-5 months, the percentage of exclusively breastfed infants was 53.4%. However, in the 0-1 month age group the percentage was 92.2 and the 23 months age group it was 83.7% (Table 1). The table clearly shows how EBF declines steadily from birth. Among infants aged 4-6 six months, 46.6% were not exclusively breastfed during the 24-hour period prior to the survey.

METHODOLOGY OF THE STUDY

The research methodology deals with the materials adopted to carry out the study. It deals with the process of oraganizing the procedure of gathering valid and reliable data for an investigation. The study was designed to enhance knowledge of mother regarding the effective breast feeding in terms of knowledge and practices in a selected community, New Delhi. The contents of the study included: 1. Introduction comprising of the definition of breast feeding, need of the study, advantages of breast feeding, different methods of breast feeding, factors affecting breast feeding, 10 steps for successful breast feeding, weaning foods. 2. Review of literature based on the previous studies. 3. Tool used in the form of questionnaire. 4. Data compilation and interpretation. 5. Critical analysis and discussion based on the findings. 6. Salient recommendations on the problem studied.

RESEARCH APPROACH According to Polit and Hungler (2009) a survey approach is a nonexperimental research that focuses on obtaining information regarding the activities, beliefs, preferences & attitudes of the people via direct questioning of a sample respondants.

RESEARCH DESIGN

According to Polit and Hungler(2009)research design is an overall plan for collecting and analyzing data including specification for enhancing the internal and external validity of the study. It helps investigation for the selection of subject, manipulation of independent variables, observation to be made, type of statistical analysis to be used in interpretating data. According to Denise.F.Polit and Cheryl Beck(2008)" research design is the overall plan for obtaining answer to questions being studied and for handling some of the difficulties encountered during the research process. In this study the Dependent variables is the knowledge and practice of mothers in terms of breast feeding. The Population is the mothers of DGD-Dujana house Jama Masjid. Setting is DGD Dujana House jama masjid.

SETTINGS OF THE STUDY

According to Nancy Burns and Susan(2003)research setting is a location in which the study is conducted. Its physical location & condition in which data collection takes place is a study. In this study the setting is DGD-Dujana house,jama masjid New Delhi. CRITERIA FOR SELECTION OF SETTING: 1. availability of setting 2. feasibility of conducting the study 3. easy access to subjects 4. co-operation & administrative support to carry out the study.

POPULATION

According to Polit and Hungler(1999)population refers the entire set of individuals/objects having some common characterstics. According to Basvanthappa(2007)population is the total group of individuals, people or things meeting the designated criteria of interest to the researcher. The population of the present study comprised of 30 mothers of DGD-Dujana House jama masjid New Delhi.

SAMPLE & SAMPLE SIZE

According to Polit and Hungler(1999) a sample is a small portion of population selected for observation & analysis. According to BT Basvanthappa(2007)sample is smaller part of population selected in such a way that the individuals in a sample represents the characterstics of the population. CRITERIA FOR SELECTION OF THE SAMPLE: 1. mothers between the age group of 18-45 years. 2. mothers who have delivered normal and healthy. 3. mothers who are willing to participate in the study. 4. mothers who are available during the period of data collection. Sample selection for the study comprised of the 30 mothers of DGD-Dujana house.

SAMPLING TECHNIQUES

According to Polit and Hungler(1999)its a process of population to represent the entire population. The process of sampling makes it possible for generalization, intended on the basis of careful observation of variables within a relative small portion of population. In the present study the samples were selected using the purposive sampling technique. In the purposive sampling the researcher deliberately selects the sampling unit to be included in the study because they are the representation of the target group.

TOOLS FOR DATA COLLECTION

According to Doorthy Young Brockopp(2003) tools are used in research to describe a particular method of collecting data. Its a device used to measure the concept of interest in a research process. DEVELOPMENT OF TOOL: The important and crucial aspect of any investigation is the collection of appropriate information which will provide necessary data to answer the question of the study. In most situations, the researcher begins by carefully defining the research variable to clarify exactly what each one means, then the researcher needs to select a design and appropriate method of measuring the variable that is the collecting of the data. Interview provides high response rate.It can be used for both literate and uneducated clients. Based on the objective of the study, structured interview to assess knowledge and practice of exclusive breast feeding was developed. Interview was constructed based on review of literature, discussion with the experts, informal discussion. This helped to determine items to be included in the tool.

VALIDITY

According to Nancy Burns and Susan(2007)validity is an extent to which an instrument accurately reflects the abstract(or concept) being examined. According to Polit and Hungler(2008)a quality criteria referring to the degree to which inferences made in a study are accurate and well founded in measurement to the degree to which an instrument measures what its intended to measure. The tool was submitted to DR.Jyoti Sharma.

METHODS OF DATA COLLECTION

The formal approval from Medical Officer Incharge of DGD-Dujana House Jama Masjid New Delhi was obtained to conduct final study on the basis of research design. Data was collected on exclusive breast feeding in terms of knowledge and practice on a sample size of 30 mothers. The investigator introduced herself and purpose of research was explained to mother. Confidentiality of their responses was assured.

PLAN FOR DATA ANALYSIS

Collected data will be organized, tabulated and analyzed. Data will be organized according to the objectives of presentability. Data will be organized and presented in appropriate forms.

GENERAL OBJECTIVES:

1. To study about the term exclusive breast feeding. 2. To study about the advantages of breast feeding. 3. To study about the various factors affecting the exclusive breast feeding. 4. To study about the weaning.

SPECEFIC OBJECTIVES: To study about the knowledge and practice of mothers in terms of breast feeding.

BIBLOGRAPHY

BOOKS: * Best John.W. research in education:6th New Delhi; Printice hall of India pvt. Ltd.1992;106-107. * K.Park; Textbook ofPreventive & social medicine;M/S Banarsidas Bhanot Publications;19th edition;349,366-368.378. * C.R Kothari Research Mehodology; New age International Publications;2nd edition;2004;18-19,122-123.

JOURNALS: * Dorman A Barbara,evaluation of breast feeding websites for patient education,MCN 31,19-21;2006. * International Journal Of Gynaecology & Obstetrics,volume 4;july-august2001;1315. *Jean,Prakash,comparison;breastfeeding versus bottle feeding;Swasth Hind;9,32,294.

WEBSITES: * www.ibfan.org * www.healthy newborn.org * www.babyfriendly.basic.com * www.lancetseries.com * www.ilca.org * www.nursingmother.org

* www.inhealth.org/breastfeeding,htm * www.internationalbreastfeedingjournal.com * www.sagepub.com * www.whiteribbonalliance.india.org

TABLE OF CONTENTS

S.NO 1 2 3

TOPIC

PAGES

Introduction Review Of Literature General & Specefic Objectives

4 5

Methodology

Observation & Finding Critical Analysis & Discussion Salient Recommendations

6 7

Bibliography

OBSERVATIONS AND FINDINGS

1. Which is the best milk for the newborn? * 28/30 (98.33%) preferred of giving breast milk to the newborns. * 2/30 (73.33%) preferred of giving cow/buffalo milk to the newborns.

Best Milk For Newborn

Breast Milk Cow/bufafalo milk

2. What would you prefer your child to feed your child soon after birth? * 20/30 (66.66%) preferred to feed with breast milk. * 6/30 (20%) preferred to feed janam ghutti/honey. * 2/30 (6.66%) preferred to feed sugar/glucose water. * 2/30 (6.66%) preferred to feed cow/buffalo milk.

Prefer To Feed After Birth

Breast Milk Janam ghutti/Honey Sugar/Glucose Water Cow/Buffalo milk

3. What are the psychological benefits from breast feeding for the mother and child? * 22/30 (73.33%) says it strengthens mother-child bonding. * 8/30 (26.66%) says that it provides emotional satisfaction for the mothers.

Psychological Benefits From Breast Feeding For Mother & Child

Strengthens mother -child bonding Emotional satisfaction for mother

4. What are the advantages of breast feeding for baby? * 30/30 (100%) says all of the above.

Advantages of breast feeding for baby

All of the above

5. What are the advantages of breast feeding for mothers? * 26/30 (86.66%) said all of the above factors. * 4/30 (13.33%) said that it saves time and energy for preparation of milk.

Advantages of breast feeding on mothers

All of the above Saves time & energy for milk preparation

6. When to start breastfeeding? * 24/30 (80%) preferred within half an hour of birth. * 4/30 (13.33%) preferred it on first day of birth. * 2/30 ( 6.66%) preferred it on the second day of birth.

When to start beastfeeding

Within half an hour of birth First day of birth Second day of birth

7. What is colostrum? * 26/30 (86.66%) says that its the first, bright yellow milk from the breast. * 4/30 (13.33%) says that its the residue milk soon after birth

What is colostrum

First,bright yellow milk from the breast Residue milk soon after birth

8. How does colostrums prevents diseases? * 18/30 (60%) says that it provides immunity to child. * 2/30 (6.66%) says that it contains vitamin-B. * 10/30 (33.33%) says that they do not know the answer.

How colostrum prevents diseases

Provides immunity Contains Vitamin-B Do not know

9. Advantages of colostrums? * 18/30 (60%) says that its a good source of Vitamin-A and protects the baby from diseases. * 12/30( 40%) says they do not know.

Advantages of colostrum

Good source of Vitamin-A & protects from diseases Do not know

10. Adequate milk is indicated by? * 22/30 (73.33%) says both (b) and (c). * 20/30 (20%) says if the baby demands for milk. * 2/30 (6.66%) says if the baby gains weight.

Adequate breast milk is indicated

Both (b) & If the baby demands for milk If the baby gains weight

11. How do you clean your hands before feeding your baby? * 26/30 (86.66%) says they wash hands with soap and water. * 4/30 ( 13.33%) says that they wash hands

How do you clean your hands before breastfeeding

With soap & water With water

. 12.Why is it necessary to wash hands before giving feeding? * 28/30 (93.33%) says to reduce number of micro-organisms. * 2/20 (6.66%) says they do not know.

Why is it necessary to wash hands before giving feeding

To reduce number of microorganisms Do not know

13. How will you clean your breast? * 22/30 (73.33%) says that they will wipe with wet cloth. * 4/30 (13.33%) says that they will wash with soap and water. * 4/30 (13.33%) says that they will wash with water.

How will you clean your breast

Wipe with wet cloth Wash with soap & water Wash with water

14. How frequently do you clean your breast? * 20/30 (66.66%) says before and after each feed. * 6/30 (20%) says that only before feed. * 4/30 (13.33%) says once in a while.

How frequently do you clean your breast

Before & after each feed Only before feed Once in a while

15. How will you hold your baby for breastfeeding? * 26/30 (86.66%) says that they will hold the baby close to their body,head slightly raised on the crook of the elbow. * 2/30 (6.66%) says that they will hold the baby conveniently. * 2/30 (6.66%) says that they will place the head on the palm of their hands.

How will you hold your baby for breastfeeding

Hold the baby close to body.head raised on the crook of the elbow Hold the baby conveniently

16. How do you prefer to breastfeed for one session? * 20/30 (66.66%) says they prefer both the sides for one session.

How do you prefer to breastfeed for one session?

Both sides for one session No preferences One side for one session

* 6/30 (20%) have no preference. * 4/30 (13.33%) prefers one side for one session.

17. When did you start feeding your child with weaning foods? * 26/30 (86.66%) says after 6 months. * 4/30 (13.33%) says when desired.

. When did you start feeding your child with weaning foods

After 6 months When desired

CRITICAL ANALYSIS BASED ON FINDING

On the basis of the data interpretation following findings were made:

1. 98.33% of women says that breast milk is the best milk for the newborn. 2. 66.66 % of mothers would prefer to feed their child with breast milk soon after birth. 3. 73.33% says that breast feeding strengthens the mother-child bonding. 4. 100% supports the various advantages of breast feeding on baby. 5. 86.66% identifies the various advantages of breast feeding on mothers. 6. 80% says that breast feeding should be initiated within half an hour of birth. 7. 86.66% says that the colostrums is the first,bright yellow milk from the breast. 8. 60% women says that colostrums provides immunity to child thereby preventing from diseases. 9. 60% women says that the most important advantage of colostrums is that its a good source of Vitamin-A and protects the baby from diseases. 10. 73.33% women says that adequate milk is indicated when the baby demands for milk and the baby micturates six times a day. 11. 86.66% women wash their hands with soap and water before feeding. 12. 93.33% women thinks that by washing hands number of micro-organisms are reduced. 13. 73.33% women wipe their breast with wet cloth cloth before feeding. 14. 66.66% women clean their beast both before and after each feed.

15. 86.66% women hold their baby close to their body with head slight;y raised on the crook of the elbow while feeding. 16. 66.66% women prefers feeding from both sides of the breast on each session. 17. 86.66% women prefers to start with weaning foods after 6 months after birth.

SALIENT RECCOMENDATIONS

1. To educate the mothers and other family members regarding the importance of breast feeding, laying more stress on exclusive breast feeding till 6 months of age. 2. The lactating mother should be given a diet rich in nutrients. 3. The socio-cultural & certain religious norms should be discouraged in order to prevent the hampering of exclusive breast feeding. 4. Institutional deliveries should be encouraged laying stress on feeding the baby within one hour of birth. 5. Knowledge should be imparted on colostrums and it advantages. 6. Health care personnals should be motivated to identify malnourished cases and refer them to the nearest anganwadi-centres or district hospitals. Continous record of their weight should be kept. 7. Knowledge to be imparted regarding the importance of weaning foods. 8. Hand hygeine and breast care should be told to mothers before and after feeding the baby. 9. Feeding the baby with janam ghutti,sugar water, formula milk and cow/buffalo milk should be strongly discouraged. 10. Burping after each feed should be encouraged.

Mothers Without You Where Would We Be..??